Your guide to over-the-counter allergy medication

Spring and summer provide ample opportunities to enjoy the outdoors, but these seasons are also prime time for allergy flare-ups.

Twenty-five percent of adults and 18 percent of children in the U.S. experience seasonal allergies, according to the Centers for Disease Control and Prevention.

If you fall into this category, you may find yourself perusing the aisles of a drugstore for relief. But how do you know which allergy medication to choose?

Gina Kim, PharmD, supervisor of MultiCare retail pharmacy services, shares insight about different types of allergy medications and which ones may be best for your symptoms.

Antihistamines

Antihistamines are the most common medication used to treat allergies. They work by blocking histamines — chemicals our bodies release when the immune system comes into contact with allergens like pollen.

Antihistamines help relieve:

• Sneezing
• Runny nose
• Itchiness
• Skin rashes or hives
• Itchy, watery eyes

Here’s what to consider when choosing an antihistamine:

• Drowsy or nondrowsy? First-generation, or older, antihistamines like Benadryl are likely to cause drowsiness and may help you fall asleep in addition to relieving symptoms. Newer antihistamines, like Allegra, Claritin or Zyrtec, are less likely to make you sleepy.
• How long do you need relief? Some over-the-counter medications, including Claritin, Allegra and Zyrtec, provide 24-hour relief, so you only need to take them once a day as needed. These allergy medications all begin working within a few hours and can safely be taken long-term.
• Are you taking other medications? Avoid taking multiple medications with oral antihistamines in them without consulting a provider or pharmacist first.

“All of the major newer antihistamines — Claritin, Allegra and Zyrtec, for example — have the same active mechanism,” Kim says. “However, some people find that one medication works better for them than others, so you may need to try different ones to see what best suits you.”

Pro tip: You may get the most relief if you take an antihistamine before exposure to an allergen (if you aren’t taking them long-term) rather than afterward.

Nasal steroid spray

Nasal steroid sprays — not to be confused with nasal decongestants — help calm the body’s immune response to allergens, reducing inflammation and swelling in the nose. Steroid sprays help relieve:

• Nasal congestion
• Runny nose
• Sneezing
• Itchy nose
• Post-nasal drip

“Consider a nasal steroid spray if your main issue is nasal congestion or if your allergies are severe,” Kim says. “You can safely use a nasal steroid spray and antihistamine at the same time.”

Some nasal steroid sprays take time (up to a few weeks) to work, and you’re likely to get the most relief if you take them every day during allergy season.

Over-the-counter nasal steroid sprays, such as Flonase, Nasacort and Rhinocort, all work in the same way. However, here are a few things to consider when choosing one:

• Scented or unscented. Flonase is scented with a synthetic floral fragrance. Nasacort and Rhinocort are unscented.
• Use of alcohol. Nasacort and Rhinocort are alcohol-free and may be gentler on the nose.
• Eye symptoms. Flonase can also help relieve itchy, watery eyes in addition to nasal symptoms.

Pro tip: Blow your nose before taking the medication. Avoid pointing the tip of the nasal spray at your septum (the middle interior of the nose), as it can cause bleeding. Instead, angle the tip toward the outer side of the nostril. Avoid blowing your nose right after use.

Decongestants

When you have a cold or experience allergies, the blood vessels in your nose may become swollen. Decongestants shrink these blood vessels, making it easier to breathe. Decongestants help relieve:

• Nasal congestion
• Chest congestion
• Sinus headaches

“Decongestants are only recommended for short-term use because they can raise your blood pressure,” Kim says. “If you’re taking decongestants every day to cope with allergy symptoms, then you should talk to your doctor.”

Decongestants come in two forms — nasal sprays and oral products. Here’s what to consider when choosing a decongestant:

• Avoid oral decongestants that have phenylephrine. Over-the-counter medications with oral phenylephrine are not effective at treating nasal congestion. Products with pseudoephedrine (like Sudafed) work better. While you don’t need a prescription for Sudafed or similar products, these medications are kept behind the counter, so you will need to request them from the pharmacist.
• Consider starting with short-acting products. If you’ve never used a product with pseudoephedrine before, Kim recommends trying the short-acting version (lasts four to six hours) over the long-acting version (lasts 12 hours) because these products can disrupt sleep and cause feelings of restlessness. People with uncontrolled high blood pressure should not take pseudoephedrine.
• Don’t use nasal decongestants for more than three days. Nasal decongestant sprays, like Afrin, can provide quick relief for nasal congestion. They may be a good alternative if oral decongestants lead to unwanted side effects. But there’s a catch. If you use a nasal decongestant for more than three days, your symptoms may rebound.

Pro tip: If you have a runny nose and nasal congestion, consider a combination antihistamine and decongestant. These products include Zyrtec-D, Claritin-D and Allegra-D.

Mast cell stabilizers

Mast cells are part of our immune system. While they help fight infections, they also play a role in our response to allergens. Mast cell stabilizers stop mast cells from releasing histamines and other chemicals, preventing allergy symptoms.

Over-the-counter mast cell stabilizers come in the form of eye drops and prevent itchy, inflamed, watery eyes. (Other types of mast cell stabilizers are available by prescription only).

Here’s what to know about over-the-counter mast cell stabilizers:

• They may contain antihistamines. Most over-the-counter mast cell stabilizers such as Pataday (olopatadine) and Alaway (ketotifen) also contain antihistamines. Pataday only needs to be taken once a day.
• They may not provide instant relief. You may need to take mast cell stabilizers for a few days before you see a noticeable change in your symptoms. To receive the most benefit, take them daily during allergy season.

Pro tip: Unlike other types of allergy medications, mast cell stabilizers prevent symptoms from happening, so if you know you get seasonal allergies, start taking these medications before allergy season starts.

When should you see a doctor?

Many people find that over-the-counter medications are enough to alleviate allergy symptoms. But you should consult with your doctor or other health care provider if:

• You are using decongestants consistently or on a daily basis
• Your symptoms are causing asthma
• Over-the-counter antihistamines aren’t working to control your symptoms or you’re experiencing disruptive side effects